Improving Rapid Response

Athletes compete against the clock.  Runners, skiers and swimmers strive endless hours to shave seconds off their race times.  Unquestioningly, the need for swiftness in a medical emergency is of paramount importance. Internal teams of nurses, physicians and professionals must constantly scrutinize their own response times to meet critical life and death emergencies.

For some time, a vital component of our patient care safety net has been our Rapid Response Team — known by some as METs or Medical Emergency Team. The heroic efforts of these teams are well known and are often forwarded to my attention.  However, in our desire to consistently strive for excellence, we sought to improve the process of the teams. Using the Operational Effectiveness approach, we targeted our response times for Code II’s and Rapid Response calls.

Recently, we held the first Rapid Response improvement event (RIE).  This was the first of six RIE’s on this improvement effort. The first RIE focus was on the flow of information and timely arrival of the first responder to a Code II or a Rapid Response call.

The team was led by Brenda Raynor, TSCU. The implementers were Kathy Sims, 10th floor and Trish Handley, CCU/Telemetry. The other team members included: Angela Marlowe, Respiratory Therapy; April Sheppard, 4East; Amy Edmund, CCU; Paula Hrobak, Anesthesia; Julie McKissick, Operating Room; and Kelly Lawson, Nursing. Larry Adams is the Process Manager for Operational Effectiveness facilitating this work.

Larry Adams and Brenda Raynor review flow chart on patient care

The RIE team spent all day on Monday and part of Tuesday understanding the “As Is” state or what is currently happening when we activate a Code II or a Rapid Response Team.  Next we developed the “Desired State” or what the ideal process should look like. By the end of Tuesday, the team developed several (PDCAs) Plan Do Check Act – - to test for improvement.

The RIE team began with a goal of having a ‘first responder’ for a Rapid Response Call or Code II Call arrive within five minutes of the request. The ‘As Is’ state was an average of twelve minutes for the first responder to arrive. By looking closely at each step, the RIE team standardized the process to call the Code II or Rapid Response through the Switchboard; thus, reducing the team’s arrival time by eight minutes.  We will now seek to educate and make responders aware of the new process so that this move toward ideal can be maintained.

As we improved response during the initial week, several Physicians provided positive confirmation. Notably, one physician stated “That was the best arrival time and rapid response I have ever witnessed.” This comment confirms that a change in process is better when it involves a team approach — including the people who ‘do the work.’ This is one of the design principles of Operational Effectiveness.

The next Rapid Improvement Event (RIE) is scheduled for the week of February 8th. This team will focus on “defining the role of each responder to a Code II or Rapid Response request by standard work and policy.”

In our use of Rapid Response Teams, we have found a team approach to nursing with subsequent improvements in patient care and outcomes: improvements in planning, which include:
- assessments, treatments and goals;
- improvements in communication – patient-to-staff, staff-to-staff and staff-to-physician; as well as
- improvements in recognizing subtle changes in a patient’s condition.

We greatly appreciate the work of this team and look forward to other breakthroughs during the next five months as they focus on each step in the process.

Thanks,
Rob

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